Obstetrical Brachial Plexus Paralysis, Part 1

The mission of these two issues (Parts 1 and 2) of Seminars in Plastic Surgery is to assemble and disseminate worldwide knowledge and experience of the microsurgical management of obstetrical brachial plexus injury. Toward this goal, experts in the field, from well-established centers around the world, have been invited to contribute. Despite stringent time restrictions, the vast majority of authors responded enthusiastically to this call. To all these contributors, I am eternally grateful.

Contributors were asked to present their institutional experiences, including their concepts, approaches, and outcomes. Experiences with both primary and secondary reconstruction are considered.

Authors were invited on the basis of their recognized contributions to the treatment of the obstetrical brachial plexus lesion. Furthermore, I invited contributions from past fellows or colleagues that have trained at Eastern Virginia Medical School and at the International Institute of Reconstructive Microsurgery in Norfolk, Virginia, or with whom I have enjoyed scientific collaboration over the past twenty years.

This first issue (Part 1) enlists institutional experiences from Saudi Arabia; Boston, Massachusetts; Aachen, Germany; The Netherlands; Taipei, Taiwan; Miami, Florida; Palo Alto, California; Osaka, Japan; Istanbul, Turkey; and Norfolk, Virginia; along with a call for a multicenter prospective study.

In addition to further institutional experiences, contributions to the second issue (Part 2) examine preoperative investigations, breech delivery, nerve transfers, and secondary reconstruction in obstetrical brachial plexus paralysis.

There is a wide diversity of opinions and approaches to the surgical treatment of the obstetrical brachial plexus lesion. No attempts have been made to critique the content of the submitted reports. Communications with authors were limited to requests for additional information to clarify concepts for our readers.

This is the first time that readers have had such a unique opportunity of exposure to experiences from recognized international centers on the topic of obstetrical brachial plexus paralysis (OBPP).

Obstetrical brachial plexus paralysis has varied severity presentations and is influenced by an array of factors including prolonged labor, large gestational size, breech presentation, and difficult delivery assisted with or without instrumentation.

Despite recent advances in obstetrics, incidences remain the same. There is great diversity of opinion regarding the optimal timing for surgery, with persistent neurologic deficits after 3 to 6 months generally accepted as indication for surgery. Compounding the clinical dilemma is the absence of a standard internationally accepted evaluation system in measuring outcomes. The experiences presented here are based on retrospective series by talented microsurgeons that provide useful clinical information on the subject. The different patterns of injury, the individual surgical approaches, and the often nonstandardized evaluation systems used, make comparisons among centers difficult. It is hoped that these early efforts will lead in the future to a scientific, evidence-based approach to the management of these crippling lesions.